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Cholesterol: How low should you go?
Drug comparison study finds there's no such thing as 'too low'
Thursday, November 13, 2003 posted: 10:24 AM EST (1524 GMT)
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ORLANDO, Florida (AP) -- A new study offers an answer to doctors' long-running debate over how far heart patients should lower their bad LDL cholesterol: As low as possible.
"There is no such thing as too low an LDL. That's what the data seem to show," said Dr. Steven Nissen of the Cleveland Clinic. He presented the results Wednesday at a meeting of the American Heart Association in Orlando.
He conducted the first head-to-head comparison of popular statin drugs. The results suggest that lowering cholesterol more aggressively than the current national guidelines recommend can completely stop dangerous clogging of the arteries.
Nevertheless, other experts caution that it is too soon to rewrite federal guidelines, although that may be in the offing as several new studies tackle this issue in the next few years.
The latest study compared two statin pills, Lipitor and Pravachol. It found that Lipitor did a considerably better job of both lowering cholesterol and controlling the insidious buildup of gunk inside the arteries when given to people with serious heart disease.
Exactly why, though, is unclear. The benefit could not be totally explained by the lower cholesterol levels. Researchers wondered if some other property of Lipitor, such as it stronger effect on inflammation, accounted for its more potent effects.
The study was sponsored by Lipitor's maker, Pfizer. Another similar but larger study is nearing completion, sponsored by Bristol-Myers Squibb, which makes Pravachol.
Guidelines recommend getting LDL, the bad cholesterol, down to 100. But many have wondered whether lower is better. The latest study lowered that target to 80 and found the more rigorous treatment seemed to stop artery clogging in its tracks.
The study involved 654 adults with LDL over 125 who had symptoms of coronary disease. They were randomly assigned to get either 40 milligrams of Pravachol or 80 milligrams of Lipitor, the top doses available of the two drugs. At the time the study began in 1999, Lipitor was considered to be the most powerful statin on the market.
The doctors used highly sensitive intravascular ultrasound to watch what happened to the buildup, known as plaque, in volunteers' heart arteries. After 18 months of typical follow-up, average LDL was 110 in the Pravachol patients and 79 in those on Lipitor.
Drugs compared
The volume of plaque in their arteries increased almost 3 percent in the Pravachol patients, while it actually regressed a fraction of 1 percent in those on Lipitor. However, the shrinkage was too small to be statistically meaningful.
Even when people on Pravachol reached the same LDL levels as those on Lipitor, their plaque buildup was worse. Nissen speculated that Lipitor's especially powerful effect on inflammation of the blood vessels could be the reason.
In this study, Lipitor lowered this inflammation, as measured by a substance called C-reactive protein, by 36 percent, while Pravachol reduced it by 5 percent.
"I think Pravachol is a good drug," Nissen said. "I just think it's not the best drug. I do respect that all statins work. But there are differences across the class."
Julie Keenan, a spokeswoman for Bristol-Myers Squibb, noted that the study did not measure actual heart complications, such as heart attacks and death, and earlier studies have shown that Pravachol reduces the risk of both.
Dr. Christopher Cannon of Boston's Brigham and Women's Hospital is directing Bristol-Myers Squibb's comparison of the two drugs and said that study will judge which one does a better job of keeping people alive and healthy.
He said Nissen's finding that Lipitor is more effective at blocking plaque is "fascinating," but he asked, "Is it important?"
Meanwhile, Dr. Raymond Gibbons of the Mayo Clinic said cardiologists will demand hard evidence that more aggressive cholesterol lowering saves lives before they make wholesale switches in therapy.
"We are not treating the people who need it, period, to even moderate LDL levels," Gibbons said. "We are not getting them to even 110. This study suggests we need to go to a new level."
Guidelines from the National Institute of Health's National Cholesterol Education Program, last revised two years ago, set LDL under 100 as the target for treatment in people with heart disease.
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Copyright 2003 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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In Reply to: cholesterol posted by whatever on November 14, 2003 at 17:54:43:
I've read that low cholestrol increases your risk of strokes. The question you need to ask about any study is not just, did it lower the risk of heart problems ( for instance), but what happened to overall mortality- do these people live longer, or do they simply die of a different cause?Of course strokes don't only kill, sometimes they merely disable, which is another concern- people left out of the mortality statistics, but with an impaired quality of life.
These are just things to think about- I don't know the right answers.
In Reply to: Re: cholesterol posted by maire on November 15, 2003 at 11:57:03:
Hi, Maire.
I have seen research that suggests that low cholesterol was related to a higher incidence of cancer and mental problems but not strokes.
Walt
In Reply to: Re: cholesterol posted by Walt Stoll on November 16, 2003 at 08:10:03:
I'm not sure where I read it, but I did see several articles about the higher incidence of strokes with too low cholesterol also. I'll try to find it again.
In Reply to: Re: cholesterol posted by Walt Stoll on November 16, 2003 at 08:10:03:
I think it's in the William Campbell Douglass MD newsletters that I've read it. He was the one who pointed out the question of overall mortality being ignored by studies of single ailments, though he didn't raise the issue of quality of life/disability- that was just my own thought, given what he talked about.
Any particular cancers related to low cholestrol or just cancer overall?
In Reply to: cholesterol posted by whatever on November 14, 2003 at 17:54:43:
There are more articles on Mercola's site about it.
Low Cholesterol Linked to Stroke Risk
High cholesterol is a well-known risk factor for stroke. But new research suggests that low levels of cholesterol in the blood may also increase stroke risk. The study linking low cholesterol to increased stroke risk was presented recently at the 24th American Heart Association Conference on Stroke and Cerebral Circulation which was discussed in last week’s newsletter. About 80% of all strokes are ischemic, and 20% are hemorrhagic.
The researchers compared the cholesterol levels of the stroke patients to 3,700 other people in the Group Health Cooperative of Puget Sound who had not had a stroke. They found that as an individual's cholesterol level rose above 230 milligrams per deciliter of blood (mg/dL), their risk of ischemic stroke increased. For example, a person with a cholesterol level of 280 mg/dL had twice the risk of ischemic stroke as a person with 230 mg/dL.
But the researchers also found that as cholesterol dropped, the risk of -hemorrhagic stroke increased significantly. A person with a cholesterol level below 180 mg/dL had twice the risk of that type of stroke compared with someone at 230 mg/dL.
About 10% of the population have cholesterol levels below 180 mg/dL. It is not clear if the cholesterol is indeed the cause of the stroke, or related to some other cardiovascular factor that is responsible. High cholesterol levels probably increase blockages.
The theory with low cholesterol is that it is necessary to maintain integrity of the vessel wall. Low levels of cholesterol might lead to "leaky vessels." The Japanese have typically low cholesterol levels and a higher than average rate of hemorrhagic stroke.
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DR. MERCOLA'S COMMENT:
It is encouraging to find some evidence (although not yet published) that shows that low cholesterol is a problem. I believe the optimum cholesterol is about 200. Levels below 180 appear to be a problem. Levels under 150 are a major dilemma. I am an expert in low cholesterol as my levels have been as low as 85.
I was trained in the "low fat" craze and I am sure I did some serious damage to my body trying to stay healthy. However, for the last seven years I had tried to raise it and was unable to get it above 135.Two weeks ago I was able to get it up to 175! For the last two months I have been using a supplement by Biotics that called Beta TCP that has whole beet concentrate and Taurine.
These items are very effective at thinning the bile in the gallbladder. Once the bile is thinned it can flow out and not remain in the gallbladder as sludge so it can emulsify the fat so we can absorb it. Trying to absorb fat without bile is like trying to wash greasy dishes without soap. It does not work very well at all. I am fairly convinced that most people with low cholesterol levels are due to a dysfunctional gallbladder.
Folks it took me SEVEN years to find someone who could teach me that piece of information. It is one of the best things I learned last year. Traditional medicine has no clue about how to treat this problem. There solution is to remove ONE MILLION gallbladders a year. I believe this is criminal malpractice. If a person is treated early enough, this operation is RARELY needed.
To add insult to injury, the surgeon does not even suggest that these patients take bile salts to help them digest their fats. If you know anyone who has had their gallbladder removed, you could greatly benefit them by telling them they need bile salts with EVERY meal for the rest of their life.
This will contribute greatly to their long term health. I use a product called Beta Plus from Biotics for this, but there are others that will work.
In Reply to: Re: cholesterol posted by maire on November 16, 2003 at 11:18:39:
Hi, Maire.
I think it was cancers, over all. However, I am sure that different cancers would be more likely than others just like smoking, etc.
Walt
In Reply to: Re: cholesterol posted by Jennifer on November 16, 2003 at 11:44:56:
Thanks, Jennifer.
I agree with this.
Walt
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